David Meldrum Executive Director

THE BIG PICTURE – where we started NDIS transforms a muddled landscape of psychosocial disability supports into a participant driven, cost effective insurance model which is consistently delivered across Australia. In the process the new system doubles the funding available.

SO Health and clinical services continue to be state managed. Eventually, the rest of the ‘mental health system’ is managed and funded by NDIA – like aged care. BUT Most jurisdictions have not agreed to that scenario – at least not yet.

SO Where has the NDIA begun implementation? With what we are agreeing to call ‘Tier 3’ in the trial sites Who is in Tier 3? People with a diagnosis (current) and associated permanent disabilities. This has proven to be a dangerously wrong assumption. Wrong because so many people in need of hands on services don’t fit either of those descriptions - ie they are in Tier 2. Dangerous because Commonwealth funding and possibly some state funding for Tier 2 services has been committed to Tier 3.

THE TRIALS You all know about these I am going to focus on the Hunter More than 60 people there have been allocated NDIS packages (very few elsewhere) Important progress has been made NSW MHS relationships PiR relationships Clarification of eligibility Building a community of practice

TIER 2 Federal Govt and NDIA now recognise the importance of ‘Tier 2’ services. In fact they recognise the case for expanding them because they are Effective Preventative Efficient Largely participant driven Some arrangements to ensure this outcome will emerge soon.

BUT Tiers 2 and 3 need much better definition - in the interests of funders, participants and service providers. My view is that where services cost in excess of around $10,000 pa, the person should become eligible for Tier 3. I don’t believe that the insurance model works for Tier 2. Block funding should continue within the usual contract management frameworks. This way we may end up with a clearer picture of Commonwealth/State responsibilities.

WHAT WE DON’T KNOW How many Australians might be eligible for Tier 3. Anybody who says they know the answer to this, is kidding themselves. All available data sets come to different answers – NMHSPF, AIHW etc Prescriptions for anti-psychotic medications shed some light on this complexity. If we build it right, some of them will come

SUMMARY Agree to protect and grow ‘Tier 2’ services. Keep talking constructively about the number of people – settle on a number for now but keep under continuous review. Keep talking about ‘permanence’ and diagnosis. Learn as much as we can from the trial sites about assessment, choice and control, about eligibility and costs. Properly and continuously engage with people who may be eligible for these services.

David Meldrum Executive Director